Outline

Objective

The advantages of the sitting position for neurosurgical procedures in the posterior fossa, the craniospinal, as well as the posterior cervical region are evident and frequently used in Germany. However, not only respiratory and haemodynamic consequences make the position uncommon and even exceptional for the old, vulnerable patient. We present our experience, the neuroanaesthesiologic monitoring and particularities within this group of patients.

Methods

We retrospectively analysed all patients aged over 65 years which were operated on for different pathologies in the posterior fossa and the posterior cervical region between 1/1999 and 11/2003. Apart from on the underlying pathology, we focussed on clinical status, cardio-pulmonary risc factors, neuroanaesthesiologic monitoring and particularities, intraoperative specialities and specific complications.

Results

139 patients over 65 years were operated on in the sitting position during the investigation period for 93 (67%) cranial and 56 (33%) cervical predominantely tumorous, traumatic, degenerative and vascular pathologies. Apart from non-specific basic monitoring, capnometry and precordial Doppler ultrasound was used as specific monitor for venous air embolism (VAE) in all patients. Preoperative diagnosis of a persistent foramen ovale was not performed routinely. Incidences of reversible VAE episodes were detected in 13 (9.4%) procedures and resolved promptly after treatment without any related permanent clinical sequels. No other complications related to the seated position were observed in these elderly patients.

Conclusions

The sitting position is effective and safe in experienced hands also in patients over 65 years of age, if appropriate surgical skills are exercised in patient selection and management. Likewise, experienced neuroanaesthesiologists and specific monitoring is mandatory.